A failure of internal jugular vein catheterization caused by the internal jugular vein occlusion

provided the original work is properly cited. CC Central venous catheterization is frequently used as the procedure for preparation of major surgery, chemotherapy, total parenteral nutrition, and etc [1]. Usually, the catheterization sites are femoral vein, subclavian vein, and internal jugular vein (IJV). Because the right IJV has easy accessibility, and it gives direct route for right atrium [2], the right IJV is a popular site of central venous catheterization. Generally, landmark technique with a seeker needle is used for right IJV catheterization. It is a blind technique. Imagine if you are performing an IJV catheterization, and there is no blood aspiration in the seeker needle. What are the possible causes? And what do you do? Our case may offer a little help. The patient was a 43 year-old male. He had been diagnosed with esophageal cancer and tracheal invasion (stage IVA, T3N1M1a) 2 years ago. Since then, he had 5 times of palliative chemotherapy and 6300 cGy of palliative radiotherapy on his neck. This patient needed general anesthesia for an Ivor-Lewis operation because of dysphasia and tracheo-esophageal fistula. In the operation room, we tried to find the right IJV with seeker needle aspiration. Despite of several trials, the aspiration failed. So, we used the ultrasound to find the right IJV. However, the ultra sound showed that the IJV lumen was distended with hypo-echoic thrombus or something, and flow was not detected in the IJV. Lastly, we cannulated the right femoral vein and the surgery proceeded. During the operation, we reviewed the neck CT images that were taken one and half years before the surgery when the patient had local infection on the right neck. Further, the CT review revealed that there was an occlusion in the right IJV (Fig. 1). We thought the cause of occlusion was tissue granulation or thro mbosis. The radiologist’s opinion was thrombosis or thrombophlebitis. As we mentioned earlier, the IJV has easy accessibility, and the procedure has performed with blind technique traditionally. Khatri and Espinosa [1] shows 29 cases of difficult circumstances encountered on the right side, out of 320 cases. The ratio is 9%. Venous thrombosis was 9 cases out of 29 difficult cases. IJV thrombus is caused by catheterization history of central venous catheter, malignancy, long term catheterization, thrombo phillia, local infection, and spontaneous occlusion [3].